Gynecological Health Concerns in Women with Schizophrenia and Related Disorders: A Narrative Review of Recent Studies

Sex and age are important factors influencing physical and mental health in schizophrenia. Our goal was to review the recent literature for associations between gynecological conditions and psychotic illness and to propose integrated strategies for their management in order to improve overall health outcomes in women. We addressed the following questions: What are the prevalence and risk factors of gynecological disorders in women with schizophrenia or delusional disorder (DD)? What are the rates of uptake of gynecological cancer screening and mortality in this population? What role does menopause play? We found an increased incidence of breast cancer in women with schizophrenia. Other gynecological comorbidities were less frequent, but the field has been understudied. Low rates of breast and cervical cancer screening characterize women with schizophrenia. Menopause, because of endocrine changes, aging effects, and resultant comorbidity is associated with high rates of aggressive breast cancer in this population. Uterine and ovarian cancers have been less investigated. Psychosocial determinants of health play an important role in cancer survival. The findings lead to the recommendation that primary care, psychiatry, gynecology, oncology, and endocrinology collaborate in early case finding, in research into etiological links, and in improvement of prevention and treatment.

Cáncer de cuello uterino. Incidencia registrada en el Hospital “Dr. Domingo Luciani” en el año 2020

Objective: To estimate the incidence of cervical cancer (CCU) in the year 2020 in the gynecology oncology consultation of the Obstetrics and Gynecology Service of the Hospital “Dr. Domingo Luciani”. Method: Retrospective, descriptive study, where the clinical histories of the patients diagnosed with cervical cancer who attended the first oncology gynecology consultation were reviewed, the period from January to December 2020. Results: Sixty patients met the inclusion criteria, the variables studied were age, histological type, stage at the time of diagnosis and indicated treatment;14.52% were diagnosed with cervical cancer; the mean age at the time of diagnosis was 43.15 years; the most common histological group was squamous, (96.67%). Regarding staging, 28 cases (46.67%) were diagnosed in stage IIIB, 14 cases (23.33%) in stage IIB, and only 6.66% were diagnosed in early stages. Treatment indicated radiotherapy and chemotherapy. Conclusion: We show in the present study that cervical cancer represents a significant percentage of gynecological consultations, that unfortunately the diagnosis is made in advanced stages, negatively affecting the prognosis of these patients and that the age at which it predominates is in full productive life of the women. affected women, constituting a real public health problem and chaos for families and society. Keywords: Cervical cancer, Incidence, Carcinoma, Adenocarcinoma, Stage

Do Steroids Matter? A Retrospective Review of Premedication for Taxane Chemotherapy and Hypersensitivity Reactions

PURPOSE Despite the widespread use of the taxanes paclitaxel and docetaxel for a variety of cancers and their well-known association with hypersensitivity reactions (HSRs), there is still significant variation in the prescribing practices of steroids for premedication. Premedication almost always includes dexamethasone, which can be associated with multiple adverse effects if taken for extended periods of time. This study reviews the pattern of steroid premedication in patients who received paclitaxel or docetaxel at Stanford Cancer Institute between January 2010 and June 2020. METHODS We used an electronic query of the electronic medical record followed up with a manual review of patient charts to ask whether we could find a correlation between steroid premedication dosing and the incidence or severity of HSRs with the first taxane dose. Variables considered included steroid dose and route, dose and type of taxane, clinical cancer group, sex, and race. RESULTS Five thousand two hundred seventeen patients were identified as having received paclitaxel or docetaxel, and 3,181 met criteria for our analysis. There were 264 (8.3%) HSRs. In adjusted multivariate analysis, we found no correlation of HSR rate or severity among any of the variables evaluated except gynecology oncology clinic patients, who had an increased risk (hazard ratio [HR] 1.34) of HSRs overall and high-grade HSRs (HR 2.34), and female patients, who had a higher rate of HSRs overall (HR 1.26), but not high-grade HSRs. CONCLUSION Neither dexamethasone dose nor route correlated with subsequent HSRs. Given the potential for adverse events from repeated high-dose steroids, our findings suggest that routine use of lower doses, such as a single 10 mg dose of dexamethasone, as premedication for taxanes to prevent HSRs is preferable to the current prescribing guidelines.

Utility of Robotic Assisted and Single Site Laparoscopy to Gynecologic Oncology

Single site laparoscopy, while in its infancy, is being explored for potential areas of application within the realm of gynecology. Gynecologic Oncology is a field with high potential benefit from the single site technique. It boasts many practical and theoretical surgical improvements, such as facilitated specimen removal, which are elaborated further in this chapter. While much more research is needed, there are exciting and uniquely useful utilities of Laparo-endoscopic Single-site Surgery (LESS) in gynecology oncology.